Inspection on 11/11/05 for Tremona Care Home

This inspection was carried out on 11th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tremona Care Home 14/07/09

Tremona Care Home 04/05/07

Tremona Care Home 09/02/06

Tremona Care Home 09/02/05

Tremona Care Home 19/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Tremona Care Home, 18 Parkers Cross Lane 18 Parkers Cross Lane Pinhoe Exeter Devon EX1 3TA Lead Inspector Ms Rachel Fleet Announced Inspection 11th November 2005 10:00 Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Tremona Care Home, 18 Parkers Cross Lane Address 18 Parkers Cross Lane Pinhoe Exeter Devon EX1 3TA 01392 460945 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Melanie Louise Brunsdon Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The manager must obtain the NVQ4 in Care by 2005 Date of last inspection 9th February 2005 Brief Description of the Service: ‘Tremona’ is a care home registered to provide personal care, support and accommodation for two younger adults with learning disabilities. The Brunsdon family also live at the premises. The home is a detached family house in Pinhoe, a residential area on the outskirts of Exeter. Upstairs, there are 3 bedrooms, a toilet and separate bathroom. A lounge, utility area and a shower room are accessed through the kitchen on the ground floor. A conservatory has been built onto the living room, leading onto a patio with enclosed garden beyond. The Home is close to a bus stop, shops, and Doctor’s surgery. Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Because the inspector had difficulty finding Mrs Brunsdon or the residents at home whenever she went unannounced, a date for the inspection was agreed a few days before it was done. The inspector was at the home for just over two hours. The two residents have come to live at the home permanently since the last inspection. At that time, they were visiting the home regularly prior to going to live there. They happily showed the inspector their accommodation, but unfortunately they were not able to give their views in detail because of limited verbal communication skills. Mr & Mrs Brunsdon do not employ any staff, and Mrs Brunsdon is the main caregiver. The Social Services care manager has arranged visiting enablers. What the service does well: What has improved since the last inspection? Updated copies of the Statement of Purpose and Service User Guide have been sent to the Commission. Aspects of medication systems (keeping of certain records and storage facilities) have been improved. Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 6 The complaints procedure has been discussed with the residents to help them understand it. A new kitchen has been fitted. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 There is good information about the care service, to help prospective residents decide whether or not they want to live at the home. Prospective residents’ individual needs are fully assessed. EVIDENCE: The Statement of Purpose sets out required information in a helpfully compact way. The Service User Guide includes pictures, and uses language in such a way as to make the document more accessible and meaningful to prospective residents. Updating is needed, to include the newly completed conservatory. Full pre-admission information about the current residents was gained from previous carers and care managers. There was also a planned introduction to the home over a period of time. This enabled Mrs Brunsdon to assess the prospective residents’ identified needs within the new care setting. She uses a very comprehensive assessment, which includes any known risks and use of public transport, for example, as well as personal care. Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6&9 Whilst care plans show residents are cared for as individuals, they do not reflect all the current needs and personal goals of residents. Residents are enabled to take appropriate risks in order to enjoy a full life. However, because risk assessments are not recorded and reviewed, risks may not be appropriately managed if needs change, affecting residents’ safety. EVIDENCE: Each resident has a care plan. However, these did not include all needs, or indicate how they are to be met in detail, and records showed they were last reviewed in February 2005. Conversation with the residents, with evidence from records, showed they lead a full life. Care plans included some household tasks that the residents participated in but only with supervision and support. No issues had been raised during the recent care management review or by the enablers who visit them regularly. However, there were no written risk assessments for outings, etc. Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Residents’ lives are eventful and enjoyed due to the range of activities and opportunities offered. This is in part due to links with the community around the Home, including residents’ friends and acquaintances. A healthy, varied diet is offered and enjoyed. EVIDENCE: Mrs Brunsdon is helping one resident look into a life skills course at a local community centre. Records showed residents had been horse riding and swimming. They talked about cookery sessions they had at their home, as well as how they helped at mealtimes, choosing what they wanted to eat for the meals on the day of the inspection. They said they liked the food, and choices discussed included healthy options. They went to day centres regularly, meeting friends there, and they still go out with their previous carers. Mrs Brunsdon takes them shopping. One resident especially enjoys clothes shopping, and is thus enabled to choose clothes for themselves. Other outings have included visits to a local stately home, and local seaside towns. Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & 20 Residents receive support in a way that acknowledges their individuality and preferences. Medication policies and procedures do not fully promote safe management of medications. EVIDENCE: The residents said they liked living at the home, and they seemed relaxed and happy. Mrs Brunsdon showed in conversations with the inspector and with the residents that she clearly knew their preferred routines, etc. Care plans are very individualised, including individual needs and preferences as to how needs should be met. A diary is used to record significant events that involve the residents – health matters and outings, for example. A care management review had been held to discuss the residents’ wish to share a bedroom, to ensure this was in the residents’ best interest before they moved from their single rooms. A list of each resident’s medication is kept, as well as a record of medicines received and of those administered on a regular basis. No medication at present is a controlled drug, or needed refrigeration. Stock is kept in a lockable facility. The residents self-administer some ‘over the counter’ medicines that the GP prescribes. At present, no record is kept of when the residents do this. Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 12 Mrs Brunsdon puts medication into ‘medidose’ boxes for later administration, because this is what the residents were used to prior to admission. However, she agreed to try to introduce administration straight from the boxes supplied by the pharmacist, since this is safer, or ask the pharmacist if he could dispense medication into ‘medidose’-type containers. A homely remedies policy is still to be produced. The existing medication policy includes ordering and administration but not disposal, nor action that must be taken in the event of a drug-error being made. Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 The home has a satisfactory complaints procedure, with evidence that residents’ views are heard and acted on. EVIDENCE: The Commission have not received any complaints about the home, and the residents did not indicate they had any concerns during the inspection. They chatted freely with Mrs Brunsdon during the inspection. Residents were listened to – their views on meals and activities were noted, for example. The complaints procedure had required information in it, and was in a format intended to be suited to the residents’ needs. Mrs Brunsdon said she had also discussed the procedure with the residents. A version seen in the Statement of Purpose needs altering, to clarify that a complainant can contact the Commission at any stage of the complaints procedure. Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 & 30 The standard of accommodation is good and well maintained – providing the residents with a comfortable, homely and clean place to live in. EVIDENCE: The home is well maintained with regard to décor, and looks orderly but homely. A recent care management review did not identify any problems with the environment for the residents. They have chosen to share a bedroom, and said they were happy with this. The bedroom was recently decorated. The home looked very clean. The washing machine, in the utility area, has appropriate programmes. Mrs Brunsdon confirmed laundry is not brought through the kitchen when food is out or being handled. Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Mrs Brunsdon does not employ any staff. EVIDENCE: Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42 The residents benefit from the way the home is managed. They can be confident that their views are used to develop and improve the care service provided. Aspects of record-keeping do not protect residents’ rights and best interests. Whilst health and safety of residents is generally well attended to, aspects need to be addressed to ensure residents’ longer-term wellbeing. EVIDENCE: Mrs Brunsdon is undertaking the Registered Managers award and NVQ4 in Care, through Exeter College; she hopes to complete the course by September 2006. She worked in care homes prior to owning her own, which she has run for over four years. As a result of her course learning, she has devised simple but effective ‘quality of care’ surveys for residents and visitors to the home (including professionals and others supporting the residents). There was evidence she had acted on Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 17 results of these – reviewing activities provided, for example, to meet requests from residents to do more cooking and some gardening. A report on her findings is to be submitted to CSCI when all the surveys have been completed. At present, one diary is used for both residents, which does not promote protection of personal data. There have been no accidents recorded since 2003, and the accident book no longer meets standards for data protection if used as originally intended. Mrs Brunsdon agreed to only make one entry on each sheet in future, to address this. Mr & Mrs Brunsdon have current first aid certificates that expire in 2007. An Environmental Health Officer visited the home in August 2005, giving advice regarding Legionella (which Mrs Brunsdon said she has acted on i.e. she has adjusted the water heater so it is stored at a higher temperature) and Food Hygiene courses that Mrs Brunsdon has since undertaken. Evacuation procedures are discussed with the residents every three months, and the fire alarm system is mains electricity powered, with battery back up. All fire safety checks have been carried out every 1-2 months only. No hazards were noted during the inspection. Mr Brunsdon has had recognised health and safety training. The Health and Safety statement for the home had not been reviewed in the last year. Risk assessments were seen for radiators, which are unguarded at present, and for door locking devices. Mrs. Brunsdon had assessed risks of falling from upper windows but not recorded it. There is no safety certificate relating to the hard wiring; Mrs Brunsdon said she is already looking into testing of portable appliances. The pre-inspection questionnaire showed the central heating had been checked in August 2005. Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X 3 X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score N/A N/A N/A N/A N/A N/A CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X 2 X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 2 3 Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9& YA42 Regulation 13(4) Requirement You must ensure that all parts of the home that residents have access to are as far as practicable free from hazards to their safety; any activities they participate in are as far as reasonably practicable free from avoidable risks; and unnecessary risks to the health & safety of residents are as far as possible eliminated. This includes recording and reviewing risk assessments in relation to residents’ needs, risktaking as part of each resident’s lifestyle, and for the environment (including windows). 2 YA42 23(4)(c) You must, after consultation with the local fire authority, make adequate arrangements for testing fire equipment at suitable intervals. This includes testing fire alarms & checking extinguishers at recommended intervals. 31/12/05 Timescale for action 31/01/06 Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations You should ensure residents’ care plans reflect their assessed & changing needs and personal goals, by a) including all aspects of personal & social support and healthcare needs as set out in Standard YA2; b) including how the service will meet these needs and any personal goals of residents; and c) reviewing them six-monthly. You should ensure residents are protected by the home’s policies & procedures for dealing with medicines, by a) Keeping appropriate records of any self-administered medicines, guided by the risk assessment for selfmedication; b) seeking guidance from a pharmacist as necessary, regarding the current use of medidose containers; c) include in the medication policy: guidance on Homely remedies, disposal of unwanted or refused medications, and action to be taken in the event of a drug error. You should ensure personal information (such as was seen in the daily diary and regarding the accident book) is kept in a way that complies with the Data Protection Act 1998. To promote the health, safety and welfare of residents and yourselves, you should: a) review the Health and Safety statement for the home regularly; and b) evidence electrical hard wiring and portable electrical appliances are safe. 2 YA20 3 YA41 4 YA42 Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V266037.R01.S.doc Version 5.0 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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